Provider Demographics
NPI:1497235626
Name:LOVE LIFE COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:LOVE LIFE COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:REZELL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAS, CCS
Authorized Official - Phone:910-287-5430
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:RED SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28377-0485
Mailing Address - Country:US
Mailing Address - Phone:910-287-5430
Mailing Address - Fax:
Practice Address - Street 1:212 ELM ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2802
Practice Address - Country:US
Practice Address - Phone:910-287-5430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20470101YA0400X
NCC0104411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty